Provider Demographics
NPI:1396199477
Name:OPTIMALIVING THERAPY LLC
Entity Type:Organization
Organization Name:OPTIMALIVING THERAPY LLC
Other - Org Name:OPTIMALIVING THERAPY & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:623-777-3113
Mailing Address - Street 1:13057 W WHISPER ROCK TRL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7952
Mailing Address - Country:US
Mailing Address - Phone:623-777-3113
Mailing Address - Fax:
Practice Address - Street 1:8953 W CUSTER LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3516
Practice Address - Country:US
Practice Address - Phone:623-777-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3809PT2251X0800X
AZ4223225XP0019X
AZ1502225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty